inpatient certification - texas

Department of State Health ServicesCenter for Health StatisticsTexas Health Care Information Collection

Inpatient Certification

Document #: 25-15002

(Formerly WebCertification)

Revised October 2020

Start Certification – Encounter on Demand (EOD) Data Reporting ScheduleLogging in CertificationViewing Older Quarters DataEncounter on DemandCertification ReportsCertification File DownloadCertifying Data

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Inpatient Certification

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After the *Cutoff for initial submission the Data Administrator (aka Provider Primary Contact) and Certifier will now receive an email a few days after the “Cutoff for Initial Submission. This email will be sent approximately sixty days after the end of each quarter. The email will have four reports attached to it:

Summary Report – use this report to validate if the data for the period is correct, such as record counts, min/max/average charges, admission type and source, payer type, patient age, gender, race, and ethnicity

Claim Count for First Physician Report - Use this to determine if the physicians (attending, operating, other) who utilize your facility are represented correctly. This report will give a claim count by physician name, sorted by name. It will also include the physician ID, but will not include patient information.

Claim Count for Second Physician Report - Use this to determine if the second physicians (attending, operating, other) who utilize your facility are represented correctly. This report will give a claim count by physician name, sorted by name. It will also include the physician ID, but will not include patient information

Error Type List Report - use this to determine if you have made all possible corrections to your data, if needed.

The email will suggest that if the Certifier determines that the data is complete and accurate after reviewing the reports, then they should consider choosing the Encounter or Event on Demand (EOD) option on their certification tab for that quarter. If you do not choose to start the EOD option, the certification process will start after the cutoff for corrections as it does now.

Start Certification - System Feature

*Cutoff for initial submission is the date when the submission data is due in the system.

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Data Due Dates

Cutoff for initial submission, date when the data is due in the system

Cutoff for corrections, is when the corrections are due by for that quarter

Facilities receive certification files, by this date System13 sends the certification files

Cutoff for corrections at the time of certification, due date for changes made to the certification data at the time of certification. Facility must contact System13 by this date to make changes. There will be a fee.

Certification/comments due, when the data has to be certified and comments (if any) needed to be inputted into the system.

The reporting schedule is a rule driven schedule, under Chapter 421, Title 25, Part 1 of the Texas Administrative Code, subchapter D, RULE §421.66. The due dates are either the 1st or the 15th of the month, if these dates are on a weekend or state observed holiday, the data is due the next business day.

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If changes are to be made to the data after the cutoff for corrections, System13 will assess a fee. Please note, cutoff for corrections at the time of certification is for facilities that make changes to their

data at the time of certification. A fee will be assessed through System13 to make these changes to data at certification.

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Certification Due Dates

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Log into the System13 system at https://thcic.system13.com

THCIC System

Log In the System as a Provider

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Put in THCIC ID username and password. Click ‘sign in’.

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A facility must accept the security notice and access to the database will be provided. If a facility declines this notice, access will not be granted to the database.

Security Notice

New Provider Dashboard

The new user dashboard for facility users that provides insights into the claim counts broken down by quarter and month as well as providing the accuracy percentage.

A graph of historical clam counts and a section with helpful tips.

The dashboard also provides key deadlines broken down by quarter as well as prominently displaying the next deadline for submission, correction and certification,.

Two views (List and Grid View).

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Certification/ Start Certification – Grid View

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Certification/ Start Certification – List View

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Go to Certification

The user can go to Certification by the provider tab Certification or by theactivity dashboard icon

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Opening Certification

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Encounter on Demand is the ability for facilities to generate quarterly certification data after the quarter has ended.

Facilities will be able to generate their quarterly certification data and the corresponding certification data reports from the time a quarter ends (example: 2q15 ends June 30, 2015.) A facility can generate the certification files for this time through the end of the corrections period for that quarter.

PLEASE BE ADVISED when a facility has chosen to begin this process, the facility must ensure the data has been submitted, is complete and accurate. If changes need to be made to this data after the file has been generated, these changes will incur a charge from System13 to regenerate the data. Also, ANYONEwith access to a UserID as a certifier can initiate the EOD and not just the system administrator for the facility.

Encounter on Demand (EOD)

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Click ‘Generate Quarter Cert. Data’, )to generate quarterly certification data and the corresponding certification data reports.

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If a facility hasn’t ran a previous quarters data they will be unable to run a requested quarter’s data. You cannot request EOD if the previous quarter has not been ran.

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A facility will have to verify twice, that the facility is requesting to generate this file.

This is the facility’s final message, an email will be sent to the Provider Primary Contact/Data Administrator when the data is available for certification, within 3 business days. The screen will show generation in progress. Once available it will show start certification.

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Once you get confirmation that the previous quarter is ready for certification, you can now start the certification for the next quarter.

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Older Quarters Data

Click ‘select quarter’ to view older quarters data.

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Select the quarter of requested data for…

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View Encounters for Older Quarters

Click ‘View Encounters’ to view previous quarters encounters’ data.

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Certification Inpatient

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Start Certification

Click ‘Start Certification’ to go to encounter view to view certification.

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List of all Encounters Generated

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The encounters are ordered by encounter ID specified by System13. The facility can click a column header and it will modify the list accordingly for that column.

The search feature to search your claim listing is also available.

Encounter View

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Once the user opens the claim correction tab, a listing of all claims that need correction will be displayed.

The user can modify the claims by:Control #Medical record # Patient Name Certification #

Once this data has been typed in to modify the list, pressing ‘clear’ will take the user back to the Certification listing.

Search for Listing for Claims

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Type in search criteria. Click search.

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Modified Search

The facility will get a modified search listing. If an encounter is chosen from the modified list just highlight and click the claim to open. To return to the regular listing just click the x in the modified menu box.

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Choose an Encounter File to View

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Encounter View – Patient Tab

Warnings…will indicate if there are encounter warnings.

To return to the encounter listing at any time click Click the tab to move through the different tabs. The tab that is being viewed will be highlighted in blue.

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Encounter View – Claim Errors

The Pink areas indicate where errors are on the data. If a facility would like to make changes to their data at the time of certification, the facility will have to contact System13. There will be a cost involved to make changes to the facility’s data at the time of certification. The Claim Correction feature is not available for claims that are being certified.

PINK

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Encounter View – Diagnosis/Procedure

The Diagnosis/ Procedure tab allows a facility to see the principal diagnosis, other diagnosis codes, admitting diagnosis, e-codes, CMS DRG, principal procedure and other procedures. When present on admission (POA) becomes available the valid codes will show, if the facility submits this information.

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Encounter View – Situational Codes

The Situational Codes tab allows a facility to view submitted Occurrence, Occurrence Span, Value and Condition Codes and associated dates.

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Encounter View – Charges

The Charges tab to see the revenue code and charge information to be reported on the patient.

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Encounter View – MedPAR

The MedPar tab and view the patient’s charges rolled into the 30 MedPAR revenue categories.

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Encounter View – Warnings

The Warnings tab to view any Encounter build issues. If there are warning on your data you must contact System13 to correct.

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Encounter View – Facility

The Facility tab allows the facility to see the facility information that will be reported and the Specialty Unit information to be reported for the specified patient. The facility will also see POA, if the facility is submitting this data.

The facility will also see POA here when available.

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Click to go back to Encounter listing.

The facility will be able to view another patient’s encounter file or go to reports and certification.

The facility will also be able to go to certification by quarter.

Back to Encounter Listing

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Click Reports and Certification

Click ‘Reports and Certification’ to go to the reports and certification for the specified year.

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Hospitals should provide their health practitioners an opportunity to review, request correction of, and comment on records of patients for whom they are shown as attending or operating.

This is probably the most difficult part of certification!

The process that facility follows is dependent upon the organizationaland logistical structure of the facility.

Factors that affect the process or amount of time involved include:Number of practitionersTeaching facilityLocation of practitioners Interest of practitioners

Each hospital is responsible for developing the process and methods for collecting comments and corrections from practitioners, and for ensuring that their concerns are acted upon.

Use of the physician reports is not required.

Provider Review of Data

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Reports, Processing Reports, Certification File Download and Certification

45The Reports will be a downloadable PDF files.

Reports Available

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Reports C01 Certification Summary

Reports C01 Certification Summary (Page 1)

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Charges breakout of all claims

Provides counts and percentages by admission source.

Provides counts and percentages of patients by type of admission.

Provides a count of the encounters built for the quarter.

Provides counts and average lengths of stays for newborn and OB combined, and all others.

Lists charges summary for the encounters.

Provides counts of newborn admissions.

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Provides counts and percentages of discharges by type of discharge.

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Provides counts and percentages by payment source, both primary and secondary.

Provides counts and percentages of discharges by type of discharge.


50Provides counts and percentages for both diagnoses and procedure codes.

Provides counts and percentages by ranges of days for patient lengths of stay.

Provides counts of encounters by level of severity of illness.

Provides counts of patients that reside in Texas, outside of the state, or outside of the country.

Provides counts and percentages of patients by ethnicity.Provides counts and percentages

of patients by gender.

Provides counts and percentages of patients by age.

Provides counts and percentages of patients by race code.

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Reports C02 Top 30 HCFA Diagnosis Related Groups (DRG’s)

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Reports C02 Top 30 HCFA Diagnosis Related Groups (DRG’s)

This report is presented in descending order by total charges for each of the top 30 HCFA DRG’s.

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Reports C03 Top 30 APR Diagnosis Related Groups

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This report is presented in descending order by total charges for each of the top 30 APR DRG’s.

Reports C03 Top 30 APR Diagnosis Related Groups

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Reports C04 Top 30 Principal Diagnosis

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Reports C04 Top 30 Principal Diagnosis

This report is presented in descending order by total charges for each of the top 30 principal diagnosis.

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Reports C05 Top 30 Principal Procedures

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Reports C05 Top 30 Principal Procedures

This report is presented in descending order by total charges for each of the top 30 principal procedures.

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Reports C06 HCFA Diagnosis Related Groups

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Reports C06 HCFA Diagnosis Related Groups

Contains information on all encounters by HCFA DRG’s.

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Reports C07 Mortality Statistics by Practitioner

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Most practitioners are interested in this report, but please verify the number of pages before printing. This report can be voluminous.

Reports C07 Mortality Statistics by Practitioner

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Reports C08 Patients by Attending Practitioner

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Reports C08 Patients by Attending Practitioner

This report can be printed for an individual practitioners or for all. To print one practitioner at a time, use the print command to select the pages to print.

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Reports C09 Patients by Operating Practitioner

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This report can be printed for an individual practitioners or for all. To print one practitioner at a time, use the print command to select the pages to print.

Reports C09 Patients by Operating Practitioner

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Reports C10 Claim Count for 1st Physician

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Reports C10 Claim Count for 1st Physician

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Reports C11 Claim Count for 2nd Physician

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Reports C11 Claim Count for 2nd Physician

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Reports C12 Certification Error Type List

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Reports C12 Certification Error Type List

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Processing Reports

The eight processing result reports describe the results of the encounter build process.

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Processing Reports DRG Errors

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The “DRG Error Report” identifies any errors that occurred during the assignment of HCFA DRG’s and APR-DRG’s.

Processing ReportsDRG Errors

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Processing Reports Duplicate Encounters

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The “Duplicate Report” will list duplicate claim errors that have occurred. If a facility has duplicate claim errors, these errors should be corrected.

Processing Reports Duplicate Encounters

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Processing ReportsEncounter Errors

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The “Encounter Edit Report” lists errors that prevented encounters from being built. Encounters were NOT created for these claims, and errors on this report should be corrected.

Processing ReportsEncounter Errors

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Processing ReportsEncounter Warnings

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Claims listed on the “Encounter Warning Summary Report” may be in error and if it is in error should be corrected.

Processing ReportsEncounter Warnings

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Processing ReportsFrequency of Encounter Errors

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This is the first page of the frequency of encounter error report regarding the number of claims received, month received and the bill type.


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Error listing will be two pages (Pages 2 & 3). It is a complete listing of all the errors by field.


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Page 4 (or it may be more pages it will depend on how many errors the facility’s claim encounters have) A complete listing of the error count, error code and error message will be included in the error summary.


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Processing ReportsHardcopy Error Report

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Hardcopy error summary report shows every error and warning on each claim.

Processing ReportsHardcopy Error Report

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Processing ReportsPractitioner Errors

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Processing ReportsPractitioner Errors

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Processing ReportsWidow Orphan Claims

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Claims on the “Incomplete Encounter and Deleted Claims Report” are either a voided claim (xx8) or incomplete encounters - admission claim (xx2) with no discharge claim.

Processing ReportsWidow Orphan Claims

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Certification File Download

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Certification File Download is the capability for facilities to request the creation of a downloadable file containing the quarterly certification data for a given quarter as long as the quarter’s certification data is accessible for viewing via the system’s certification page.

The file will be in a fixed length format and the data layout will be downloaded with the file. This will allow a facility to analyze the data with software analysis tools of the facilities choice.

BE AWARE that once this file has been requested, it should be available within 24 hours. An e-mail will be sent to the Provider Primary Contact/ Data administrator on file when this data is available for download. Please be advised, ANYONE with access to the provider login/ password can initiate the certification file download and not just the Provider Primary Contact/ Data administrator for the facility.

The file will be available for downloading for 30 days. The download file will be removed from the system after 30 days from the date of the download file creation.

There will be a fee if a facility requests this file again after the 30 day review period. If a facility would like another creation of this file, there will be a fee accessed through System13. It is important that the file is downloaded within 30 days of requesting its creation to avoid any fees.


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Certification file download This capability will allow a facility to request the creation of a downloadable file containing the quarterly certification data for a given quarter. This file will be available as long as the quarter’s certification data is accessible for viewing via the system’s certification page.

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Certification file download - Click load Cert. to get a download of the quarters encounter files. The file will be in a fixed length format. The data layout will be downloaded with the file. This download will allow the facility to analyze the data with software analysis tools of the facilities choice.

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Certification file download - This will show ‘Retrieve Cert. Data File’ when the file is ready to be downloaded. A facility has 30 days from when the file is ready for download to download the file without any charges being occurred.

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The download zip file will consist of the following:

Your file containing the Certification Data (in a fixed length format – for saving/processing with your tools) is available for downloading. You must download the file to your computer within 30 days. After 30 days the file will be removed and there will be a fee charged for the regeneration of the file.

Please Note: The record structure of the files has changed beginning with 4q15 data. The record structure is located in the CSV file. Please notify anyone using this data of this change.

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The download zip file will consist of the following:

Your file containing the Certification Data (in a fixed length format – for saving/processing with your tools) is available for downloading. You must download the file to your computer within 30 days. After 30 days the file will be removed and there will be a fee charged for the regeneration of the file.

Please Note: The record structure of the files has changed beginning with 4q15 data. The record structure is located in the CSV file. Please notify anyone using this data of this change.

This will allow the facility to analyze the data with software analysis tools of the facilities choice.

Please be advised that once a facility requests this file, the file will be created and available for downloading for 30 days. The download file will be removed from the system after 30 days from the date of the download file creation.

There will be a fee for each additional time the file is created; therefore, download the file and save the file within 30 days of requesting its creation to avoid any fees.


Changes to Data at The Time of Certification

If a facility would like to make changes to their data at the time of certification, the facility will have to contact System13 at 1-888-308-4953.

There may be a fee involved to make changes at the time of certification. These fees will be between the facility and System13.

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Certification

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Certification – Update Certifier

The name of the certifier of record will appear as provided to THCIC. If there is no certifier name, this must be updated before a facility can certify. If this certifier is no longer with the facility, the facility must update this information with THCIC by completing a Facility Information Request. Click update certifier name to be redirected to the THCIC form.

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Update Certifier Name

This window will open to update your certifier information. Click THCIC Health Facility Information Request Form to be directed to a form to fill out and return.

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Certification

Certification Options

Certified without comments. Certifies that the data is accurate “as is” and comments are not required to be attached with the release of the data.

Certified with comments. Certifies the data is accurate “as is” with comments attached with the release of the data.

Elects not to certify*. Unable to complete the certification process due to circumstances outside of the facility’s control or facility refuses to certify the data.

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*Note: Electing not to certify does not prevent the data from being placed in the Public Use Data File (PUDF).

DO NOT SEND COMMENTS ON PAPER, FAX OR E-MAIL. THCIC CANNOT RETYPE FACILITY COMMENTS. PLEASE TYPE FACILITY COMMENTS IN THE COMMENT ON THE CERTIFICATION PAGE.

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New Certification Feature

**PLEASE NOTE: Before a facility can certify or elect not to certify, you are required to download a certification report.

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**PLEASE NOTE: After you download a certification report, you will be able to certify your data.

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Certification - Elect Not to Certify

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A facility can elect not to certify if a facility is unable to complete the certification process due to circumstances outside of the facility's control or facility refuses to certify the data. Please be advised electing not to certify does not prevent the data from being placed in the Public Use Data File (PUDF).

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Please note: If you elect not to certify, you must provide a statement as to why you are electing not to certify this data. You may call the help desk and arrange to regenerate and correct your facility's data, if needed.

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When a facility elects not to certify, a statement must be entered into the comment section stating the reason for not certifying the data. **Elect not to certify is not a valid statement. After the comments are entered, click elect not to certify again.

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Confirmation - Elect Not to Certify

This is the confirmation page that the data has been elected not to certify. A confirmation email will also go to the certifier of record.

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Confirmation - Elect Not to Certify Email

The certifier of record will get this email when the data has been elected not to certify.

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Certification – Certify

Click certify to certify the data is accurate “as is”.

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Certification - Certify

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Certification - Certify

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Confirmation - Certify Email Confirmation

The certifier of record will get this email when the data has been certified.

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Certification – Certify With Comments

Please put comments in the comments field, if you are certifying your data is accurate “as is.” and releasing comments with your data. Once you have entered your comments, click certify.

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Type in comments to be released with the facility’s data, in this section. The comments can be typed in a word document (or other document), cut and pasted in the comment section. PLEASE NOTE:To maintain confidentiality, comments must not disclose the identity of patients or physicians.

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When a facility elects to certify with comments, please add your comments in the field before you click to certify this data.

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Confirmation - Certify With Comments Email Confirmation

The certifier of record will get this email when the data has been certified with comments.

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Certification Completed/ Status

When a facility is ‘Past cut-off date for generation of Cert. Data’ this message means that the facility cannot use ‘Encounter on Demand’, which will allow a facility to start certification before it is facilitated by System13.

When a facility clicks Certification and data has been certified, elected not to certify or failed to certify the facility will see the messages on the certification page by the quarter in question.

If a facility wants to change the status, correct or regenerate their certification files, the facility will have to contact System13.

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Certification Completed/ Activity Dashboard – Grid View

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Certification Completed/ Activity Dashboard – List View

What does it mean to “certify” the data?

It indicates that your facility confirms that:

◦ policies and procedures are in place within the facility's processes to validate and assure the accuracy of the data and any corrections submitted; and

◦ all errors and omissions known to the facility have been corrected or the facility has provided comments describing the errors and the reasons why they could not be corrected; and

◦ to the best of their knowledge and belief, the data submitted accurately represents the facility's administrative status of data for the reporting quarter; and

◦ the facility has provided physicians and other health professionals that were reported in the data a reasonable opportunity to review and comment on the data.

If a facility does not certify the data, will it be penalized?

No; however, when the data are released, documentation created by THCIC will indicate your facility “Failed to Certify”. It would be public interpretation as to what “Failed to Certify” means.

What if facility selects the “Elects Not to Certify” method?

Detailed written justification must be provided in the “comment” area explaining the decision to not certify the data. The written justification will be released to the public.

NOTE: Any certification comment or written justification must NOT reveal the identity of a patient or physician. All certification comments and written justifications will be released to the public.

What happens if a facility misses a certification due date?

There are no extensions to the certification due date.

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Certification Information

Certification

Questions/ Comments

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Questions, comments or need clarification please e-mail [email protected]

The e-mail should include the facility’s THCIC ID.

THCIC Contact Address:Texas Health Care Information Collection Dept of State Health Services – Center for Health Statistics1100 W 49th St, Ste M-660Austin, TX 78756

Phone: 512- 776-7261Fax: 512- 776-7740E-mail: [email protected] site: http//:www.dshs.texas.gov/THCIC

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Contact Tiffany Overton at 512-776-2352 or [email protected] if a facility has

questions concerning the submission, correction, or certification of data.

Contact Dee Roes at 512-776-3374 [email protected] if submitter

test/production files reject due to a submission address or EIN/NPI number.

For general questions or to request information about THCIC please e-mail to [email protected].

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THCIC Contact

System13 Contact

Address:System13, Inc1648 State Farm Blvd.Charlottesville, VA 22911

Phone: 1-888-308-4953Fax: 434-979-1047E-mail: [email protected] site: https://thcic.system13.com

135Document #: 25-15002

inpatient certification - texas

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